Can OCD Cause Mood Swings?

A mood swing, also known as a sudden or intense change in your emotional state, can happen for lots of reasons—but if you have obsessive compulsive disorder (OCD), you might be wondering if there’s a connection between the disorder and your tendency to fluctuate from content one moment, to angry, upset, or distressed (or fill-in-the-blank emotion) the next. 

Keep reading to find out whether OCD is the root cause of your mood swings, and how to cope.

What is OCD?

Obsessive-compulsive disorder is a mental health condition in which a person experiences recurring intrusive thoughts (or images/urges/sensations/feelings) that prompt them to perform an action—or mental act—to try to “counterbalance” or escape the thoughts. The intrusive thoughts are known as obsessions, and the physical or mental behaviors used to try to neutralize the thoughts are known as compulsions.

Obsessions do not align with a person’s real values or desires. For instance, in the case of Harm OCD, a subtype of OCD that involves fear of causing harm to yourself or others, you might have an intrusive thought about running people over with your car—when that’s the last thing you want to do. Likewise, as part of Relationship OCD (ROCD), you may have recurring negative thoughts about the “doom” of your relationship—when that’s the opposite of your true desire, to be with the person you love. 

It’s no wonder that OCD causes so much discomfort and distress—which OCD sufferers try to escape with compulsions. The problem is that compulsions, while they may be helpful in the short-term, don’t work long-term.

What are OCD mood swings?

OCD mood swings refer to rapid and intense variability in emotional state that occurs over short periods of time, often within hours. Mood swings in OCD include a range of emotions, including anxiety, anger, frustration, rumination, guilt, shame, and temporary relief. In a 2012 study of people in the UK with OCD, 67% had mood instability.

So why do OCD mood swings happen? Well, as mentioned earlier, when an intrusive thought comes up, or when a compulsion can’t be performed—or doesn’t bring satisfying relief—a person with OCD can experience rapid shifts in their mood as a result of feeling unsettled. Mood swings also occur when people with OCD are overwhelmed by their obsessions and compulsions and can’t go through daily life without them occupying their mind or their actions. 

“People with OCD imagine horrible, awful things happening because they couldn’t do a compulsion, then they’re very, very anxious,” says NOCD Chief Clinical Officer Patrick McGrath, Ph.D. “That shift could happen in a matter of minutes.” McGrath notes that OCD mood swings are most likely to occur when the disorder isn’t dealt with using specialized treatment. 

Sign you’re experiencing an OCD mood swing

OCD mood swings show up differently for everyone. For one thing, mood changes can range from moderate fluctuations to more intense or significant shifts in emotional state. 

That said, unwanted thoughts and compulsions can bring about a number of common emotional experiences, including:

• Anger: People with OCD frequently rely on rationalization or reassurance from friends or family members after having an intrusive thought. When that reassurance isn’t given or available, it can bring up feelings of anger or frustration. 

• Hopelessness or depression: Because intrusive thoughts are persistent in people with OCD, they can be overwhelming without proper OCD treatment, leading to hopelessness or sadness. That can look like changes in sleep patterns, appetite, or energy levels.

• Anxiety or panic: Rumination, or dwelling on negative feelings or emotions, is a compulsion that many people with OCD experience. That kind of thought pattern can lead to anxiety or panic when it’s constant and untreated. Anxiety may also come up when a person with OCD is unable to perform a compulsion that would normally neutralize an intrusive thought.

What’s the link between OCD mood swings and bipolar disorder?

Sometimes when people with OCD experience mood swings, they give themselves a label: “I’m being so bipolar today!” While “bipolar” is used in our culture as an adjective to describe someone who is moody, it’s actually a real mental health diagnosis. The mood disorder causes severe changes in emotional state, activity levels, energy, and concentration, and  may come with episodes of mania and depression. Mania refers to emotional highs that can include feelings of uncontrollable excitement, irritability, and impulsivity. Meanwhile, depressive periods often include feelings of sadness, lethargy, or worthlessness.

OCD and bipolar disorder are very different. For one, bipolar disorder doesn’t involve obsessions and compulsions. Likewise, “with bipolar disorder, patients usually have severe depressive episodes or mania—that looks like acting out, spending money—things that I just don’t see people with OCD doing,” McGrath says. “People with OCD, on the other hand, are afraid of ‘what if I were to have a manic episode’ but don’t actually have them.”

That said, the two conditions can overlap. A 2015 study found that those with bipolar disorder are more likely to exhibit symptoms of OCD, compared to those with no diagnosed mental health illness. “OCD doesn’t often travel alone,” says McGrath, meaning that “if you have OCD, it’s not uncommon to have a second condition.”

But be cautious of jumping to conclusions about: “I tell patients with OCD that just because they have symptoms of other conditions, they don’t have to pathologize it,” McGrath says. “Just because you have a mood swing doesn’t mean you suddenly have mania and bipolar disorder.” As always, it’s best to see a mental health professional who can rule out or confirm a diagnosis.

If you do have it, bipolar disorder is most often treated with a combination of mood stabilizing medication and cognitive behavioral therapy (CBT), which involves identifying and reframing negative thought patterns. OCD, on the other hand, is treated with another, hyper-specialized therapy that is specifically designed to interrupt the cycle of obsessions and compulsions.  

How to manage OCD mood swings

If you’re having OCD mood swings, the best way to cope is—you guessed it—to treat the underlying OCD. Exposure and Response Prevention (ERP), a type of evidence-based therapy, is widely regarded as the most effective treatment for OCD, and it can go a long way in helping to regulate mood swings associated with the disorder. 

Treatment through ERP involves gradually exposing people with OCD to situations or thoughts that trigger their obsessions, and then helping to prevent the accompanying compulsive behaviors through response prevention techniques. ERP never puts you in a highly distressing situation to begin with—the work is gradual, and includes the guidance of your ERP therapist so you don’t get too overwhelmed.

Here’s an example: If you have Contamination OCD, you might be encouraged to pick up a communal pen at the bank teller, even if you’re not sure who has touched it. Instead of running to wash your hands, you sit with the discomfort, or delay the compulsive behavior. Over time, you might be ready to try something that triggers a higher degree of fear, such as using the makeup tester at a drugstore.

In addition to professional help, lifestyle habits like getting good sleep and regular exercise— two natural mood stabilizers—can help manage OCD mood swings.

Finally, a bit of perspective: “Everyone has mood swings, there’s nothing wrong with that,” McGrath says. “The challenge for people with OCD is that they believe everything that’s going on with them must be a problem or diagnosis, they overreact to stuff all the time. In treatment we remind them that there’s no need to do that.”